Improving practice in accessing haemodialysis central venous catheters

In children, haemodialysis is used as a form of renal replacement therapy and is typically delivered via a central venous catheter (CVC). It is necessary to access the CVC for dialysis and blood sampling regularly, and safe line practice is essential to minimise complications associated with CVCs, including infection. The authors had concerns about the rate of CVC infection in their children's haemodialysis unit, which prompted a practice review. A questionnaire was emailed to all other children's haemodialysis units in the UK, which identified variations in practice and training. The authors subsequently modified their unit's CVC access guidelines and blood sampling technique, and developed a new competency-based 'haemodialysis CVC access only' training programme for nursing staff. A willingness to review practice in the unit, supported by comparison and communication with other units, assisted in implementing this change in practice.